Hemorrhage from penetrating injuries to the torso represents between 19-28% percent of military injuries with increases noted among the most recent conflicts. Among modern military injuries regarded as potentially survivable, over 80% are related to hemorrhage. More specifically, noncompressible hemorrhage related to injury of the torso represents half of all potentially survivable injuries. The most serious hemorrhagic injuries of the torso would be expected from injuries to the aorta.
In the current era of aortic stent grafts, repair of these injuries can be relatively straightforward, but only in facilities with proper fixed fluoroscopic imaging equipment and endovascular expertise. Because blood loss can be rapid from these injuries, the major issue becomes how to transport patients from the location where the injury is sustained (e.g., the front line of a battlefield) to a medical facility before they have sustained significant blood loss. Aside from the obvious hemodynamic effects of hemorrhage, blood loss is strongly associated with ensuing coagulopathy, multi-organ failure as well as initiating conditions such as Systemic Inflammatory Response Syndrome. These increase the acute complexity of trauma patients, extend long term intensive care management, and increase the risks for other complications such as long term organ failure, even despite eventual replacement of lost blood volume.
Accordingly, a significant need exists for devices and methods that can be used to minimize or prevent blood loss from injuries to the aorta until the patient can be transported to a medical facility where the injury can be repaired.
Open repair of perivisceral aortic pathology is complicated by issues of distal ischemia during repair in both military (traumatic) and civilian (aneurysm) settings. The conventional clamp and sew approach increases the risk for organ failure, lower extremity ischemia and paraplegia. Alternately, distal aortic perfusion by means of a left heart bypass entails increased complexity including additional perfusion equipment, increased expertise on the part of the surgeon and additional operative exposure. Further, the necessary equipment may not be available at many facilities. Accordingly, a significant need exists for improved, easy to use devices that can allow for perfusion of arteries downstream of an injured or diseased portion of the aorta during complex open aortic repair.